Guidelines for Indication and Management of Pregnancy and Delivery in Women With Heart Disease (JCS 2010) - Digest Version -

Warfarin‐associated fetal intracranial subdural hematoma: a case report

“…These patients are at a high risk of thromboembolism, and it is recommended that warfarin should be switched to heparin therapy during the 6–12th week of gestation for the concern of teratogenicity and 2–3 weeks before delivery for possible maternal and/or fetal hemorrhages during delivery. During other periods, the use of warfarin is recommended [ 2 ]. However, because warfarin can cross the placenta, there is concern over the impact of this drug on the fetus.…”

“…A study on the use of heparin alone throughout pregnancy showed that thromboembolic complications and maternal death occurred in 25% and 6.7% of subjects, respectively [ 1 ]. Because the preventive effect of heparin on thrombosis is uncertain, switching to oral administration of warfarin is necessary [ 2 ]. Because warfarin crosses the placenta, it can cause complications in both mothers and fetuses.…”

Adult Congenital Heart Disease with Pregnancy

“…White blood cell counts increase up to 13,000/mm especially neutrophils. 2) Platelet counts slightly decreases. In late pregnancy, anticoagulant factors such as plasma fibrinogen, von Willebrand factor and coagulation factors I, V, VII, VIII, X, and XII are activated.…”

“…Hemodynamics during pregnancy and delivery is significantly affected by changes in fluid circulation, hematology, respiratory function, endocrinology and autonomic nervous system ( Tables 2 and 3 ) ( Figure 3 ). 2) 3) Plasma volume begins to increase from 4 weeks of gestation, peaks at 32 weeks of gestation, and then is maintained at a similar level or increase gradually to the volume 40–50% higher than before pregnancy. 4) 5) Heart rate peaks at around 32 weeks of gestation to about 20% higher than before pregnancy.…”

“…Those with PH, severe left ventricular (LV) outflow tract stenosis, cyanotic CHD, aortic root dilatation/aneurysm, cardiac dysfunction, Fontan procedure, Kawasaki disease (KD) with coronary artery stenosis, mechanical valve carry a high risk for both the mother and the fetus ( Table 1 ). 1) 2) While many women with CHD tolerate the hemodynamic changes of pregnancy, others may face significant immediate or late risks of pregnancy including volume overload, arrhythmias, progressive cardiac dysfunction, thrombosis and death ( Figure 2 ) during pregnancy, delivery and the postpartum especially in women with moderate to severe CHD, but fortunately, most of these complications could be managed. Management of complications is firstly rest, followed by medication and intervention (catheter or surgery), in some cases, termination is necessary if fetus is enough growing, especially after 28 or 30 weeks of gestation.…”